本文選題：椎動(dòng)脈 + 夾層動(dòng)脈瘤　； 參考：《首都醫(yī)科大學(xué)》2017年碩士論文

【摘要】：目的:分析影響顱內(nèi)椎動(dòng)脈夾層動(dòng)脈瘤血管內(nèi)治療的手術(shù)方案選擇和手術(shù)安全性的相關(guān)因素,探討顱內(nèi)椎動(dòng)脈夾層動(dòng)脈瘤的個(gè)體化、規(guī)范化治療策略。方法:回顧性收集我院神經(jīng)介入科及協(xié)作醫(yī)院自2009年2月到2016年11月142例診斷為顱內(nèi)椎動(dòng)脈夾層動(dòng)脈瘤的患者的臨床資料,設(shè)定入組排除標(biāo)準(zhǔn)后125例連續(xù)性病例共133例椎動(dòng)脈夾層動(dòng)脈瘤納入本研究。重點(diǎn)分析動(dòng)脈瘤大小、占位大小、狹窄程度、是否破裂、是否累及小腦后下動(dòng)脈以及對(duì)側(cè)椎動(dòng)脈的代償是否良好等椎動(dòng)脈夾層動(dòng)脈瘤特點(diǎn)數(shù)據(jù),將以上特點(diǎn)與治療方案選擇、圍手術(shù)期缺血性并發(fā)癥和出血性并發(fā)癥進(jìn)行單因素、多因素分析。結(jié)果:13例(9.77%)夾層動(dòng)脈瘤實(shí)施了載瘤動(dòng)脈閉塞術(shù),120例(90.23%)進(jìn)行了重建性手術(shù);重建性手術(shù)中支架輔助彈簧圈栓塞93例(69.92%),單純支架治療11例(8.27%),密網(wǎng)支架治療16例(12%)。術(shù)后缺血性并發(fā)癥10例(8%),術(shù)中破裂或術(shù)后再出血6例(4.8%),抗血小板藥物相關(guān)性出血4例(3.2%)。102例(82%)進(jìn)行了2.03±1.63年的臨床電話隨訪,其中74例(59%)患者進(jìn)行了0.95±0.87年的影像學(xué)隨訪,良好預(yù)后(mRS2)率為85%,復(fù)發(fā)率為9%。患者在治療方案選擇方面,較高的狹窄率與累及PICA與載瘤動(dòng)脈閉塞術(shù)密切相關(guān)。累及PICA和進(jìn)行載瘤動(dòng)脈閉塞術(shù)是缺血并發(fā)癥發(fā)生的獨(dú)立危險(xiǎn)因素。較高的狹窄率和不完全栓塞是術(shù)中出血或術(shù)后再次破裂的獨(dú)立危險(xiǎn)因素。結(jié)論:對(duì)于顱內(nèi)椎動(dòng)脈夾層動(dòng)脈瘤,經(jīng)過(guò)個(gè)體化選擇進(jìn)行閉塞性手術(shù)或重建性手術(shù)的血管內(nèi)治療是安全有效的。對(duì)于伴發(fā)狹窄的顱內(nèi)椎動(dòng)脈夾層動(dòng)脈瘤,如果病變不累及小腦后下動(dòng)脈,更傾向于選擇載瘤動(dòng)脈閉塞術(shù),但同時(shí)須警惕缺血并發(fā)癥的風(fēng)險(xiǎn)。對(duì)伴發(fā)較高程度狹窄的椎動(dòng)脈夾層動(dòng)脈瘤進(jìn)行治療時(shí)和無(wú)法完全栓塞時(shí)應(yīng)警惕出血并發(fā)癥的風(fēng)險(xiǎn)。
[Abstract]:Objective: to analyze the factors that affect the choice of operative scheme and the safety of endovascular treatment of intracranial vertebral dissecting aneurysm, and to explore the individualized and standardized treatment strategy of intracranial vertebral dissecting aneurysm. Methods: the clinical data of 142 patients diagnosed as intracranial vertebral artery dissecting aneurysms from February 2009 to November 2016 were retrospectively collected. A total of 133 vertebral dissecting aneurysms were included in the study after the exclusion criteria were established in 125 consecutive cases. The characteristics of the aneurysm, such as the size of the aneurysm, the extent of stenosis, the rupture of the aneurysm, the involvement of the posterior inferior cerebellar artery and the compensatory effect of the contralateral vertebral artery, were analyzed. Ischemic and hemorrhagic complications during perioperative period were analyzed by single factor and multi-factor analysis. Results one hundred and twenty patients with dissecting aneurysms underwent reconstructive operation, 93 of them were embolized with coils, 11 were treated with stents alone, and 16 were treated with dense mesh stents, and 12 patients were treated with stent-assisted coils during reconstructive surgery, 11 patients with dissecting aneurysms were treated with occlusive aneurysms and 90.23patients were treated with stent-assisted coil embolization, 11 patients were treated with stents alone, and 16 patients were treated with dense mesh stents. 10 cases with ischemic complications, 6 cases with intraoperative rupture or postoperative rebleeding, and 4 cases with antiplatelet drug-associated hemorrhage were followed up by telephone for 2.03 鹵1.63 years, 74 of whom were followed up for 0.95 鹵0.87 years. The rate of good prognosis was 85% and the recurrence rate was 9%. The high rate of stenosis was closely related to the involvement of PICA and aneurysm occlusion. PICA involvement and aneurysm occlusion are independent risk factors for ischemic complications. High stenosis rate and incomplete embolization are independent risk factors for intraoperative bleeding or rerupture. Conclusion: for intracranial vertebral artery dissecting aneurysm, it is safe and effective to choose the endovascular treatment of occlusive operation or reconstruction operation. For intracranial vertebral artery dissecting aneurysms with stenosis, if the lesion does not involve the posterior inferior cerebellar artery, it is more likely to choose the aneurysm artery occlusion, but at the same time, the risk of ischemic complications should be warned. The risk of bleeding complications should be observed in the treatment of vertebral dissecting aneurysms with high degree of stenosis and in cases of incomplete embolization.
【學(xué)位授予單位】：首都醫(yī)科大學(xué)
【學(xué)位級(jí)別】：碩士
【學(xué)位授予年份】：2017
【分類(lèi)號(hào)】：R651.12

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本文編號(hào)：1841206